Homepage Fill Out Your 680 Form
Article Structure

The Florida Certification of Immunization, commonly referred to as Form 680, plays a crucial role in ensuring that children in the state are protected against preventable diseases. This form is not only a means of documenting immunization but also serves as an important legal document required for school attendance, daycare enrollment, and other child-related activities. It captures essential information, including the child’s name, date of birth, and immunization records, covering a variety of vaccines such as DTaP, MMR, Hepatitis B, and more. Parents or guardians must fill in specific doses received and their corresponding dates while certifying the completeness of the immunization schedule. The form accounts for different situations, allowing for temporary exemptions for children still in the process of receiving required vaccinations and permanent medical exemptions when certain immunizations are contraindicated due to health reasons. Moreover, guidelines for completing the form and understanding its implications are readily available to ensure compliance with state regulations. As such, Form 680 is not just a bureaucratic requirement; it reflects a community commitment to safeguarding the health of children and, by extension, the broader public health landscape.

680 Example

FLORIDA CERTIFICATION OF IMMUNIZATION

Legal Authority: Sections 1003.22, 402.305, 402.313, Florida Statutes; Rule 64D-3.046, Florida Administrative Code

 

 

 

 

 

 

 

 

 

 

LAST NAME

 

FIRST NAME

 

MI

 

DOB (MM/DD/YY)

 

 

 

 

 

 

 

 

 

 

PARENT OR GUARDIAN

 

CHILD’S SS# (optional)

 

STATE IMMUNIZATION ID# (optional)

 

 

 

 

 

 

 

 

 

 

Directions:

Enter all appropriate doses and dates below.

Sign and date appropriate certificate (A, B,or C) on form.

See DH Form 150-615, Immunization Guidelines - Florida Schools, Childcare Facilities and Family Daycare Homes (July 2010) for information and instructions on form completion. Guidelines are available at: www.immunizeflorida.org/schoolguide.pdf.

VACCINE

DOE

Dose 1

 

Dose 2

 

Dose 3

 

Dose 4

 

Dose 5

 

CODE

MM/DD/YY

 

MM/DD/YY

 

MM/DD/YY

 

MM/DD/YY

 

MM/DD/YY

DTaP/DTP

A

 

 

 

 

 

 

 

 

 

DT

B

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Tdap

P

 

 

 

 

 

 

 

 

 

Td

Q

 

 

 

 

 

 

 

 

 

Polio

D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hib

E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MMR (Combined)

F

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Separate)

G, H

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Measles (dose 1)

 

Measles (dose 2)

 

Mumps (dose 1)

 

Mumps (dose 2)

 

 

 

I

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rubella (dose 1)

 

Rubella (dose 2)

 

 

 

 

 

 

Hepatitis B

J

 

 

 

 

 

 

 

 

 

Varicella

K

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Varicella Disease

L

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Year

PneumoConju N

Select appropriatebox(es)

Certificate of Immunization forK-12

Part A-Complete

DOE Code 1: Immunizations are complete K-12 (Excluding 7th grade/middle school requirements)

DOE Code 8: Immunizationsare complete for 7th grade

I have reviewed the records available,and to the best of my knowledge, the above named child has adequately been immunized for school attendance, as documented above.

Temporary Medical Exemption

Expiration date: _____________

Part B-Temporary

 

Part B (For children in daycare, family daycare homes, preschool, kindergarten and grades 1 through 12 who are incomplete for immunizations in Part A) Invalid without expiration date. DOE Code 2

I certify that the above named child has received the immunizations documented above and has commenced a schedule to complete the required immunization. Additional immunizations are not medically indicated at this time.

Permanent Medical Exemption

Part C-Permanent

Part C (For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption.) DOE Code 3 ________________________________________________________________________________________

I certify the physical condition of this child is such that immunizations as indicated in Part C above are medically contraindicated.

Physician or Clinic Name:

Physician or

_________________________________________________

Authorized Signature: ____________________________________

_________________________________________________

Issued By:_____________________________________________

_________________________________________________

Date: _________________________________________________

DH 680 (Jul 2010) Stock Number: 5740-000-0680-6

Form Characteristics

Fact Name Description
Legal Authority The legal basis for the form includes Sections 1003.22, 402.305, and 402.313 of the Florida Statutes, as well as Rule 64D-3.046 of the Florida Administrative Code.
Required Information The form requires details such as the child's name, date of birth, vaccination dates, and parental or guardian information.
Immunization Codes Specific vaccine codes and completion codes (e.g., DOE Code 1 for complete immunizations) must be filled out to ensure compliance.
Exemptions The form includes options for temporary and permanent medical exemptions for vaccination, along with applicable reasoning for exemptions.

Guidelines on Utilizing 680

Completing the Florida Certification of Immunization (Form 680) is an important step for ensuring child's readiness for school. This form needs to be filled out accurately to reflect the child's immunization status. Here’s a straightforward guide to help you through the process.

  1. Gather Necessary Information. Before starting, have the child's full name (last name, first name, middle initial), date of birth, and social security number (if available) on hand. You’ll also need information about the parent or guardian.
  2. Fill in Child’s Basic Details. In the spaces provided, enter the child’s last name, first name, middle initial, date of birth in MM/DD/YY format, the parent or guardian's name, child’s social security number, and optional state immunization ID number.
  3. Document Immunization Records. For each vaccine listed, enter the date (MM/DD/YY) when the child received the immunization in the appropriate Dose columns. Make sure to complete all doses applicable.
  4. Select the Appropriate Certificate. Choose from Part A, Part B, or Part C based on the child’s immunization status:
    • Part A for complete immunizations.
    • Part B for temporary exemptions.
    • Part C for permanent medical exemptions.
  5. Sign the Certificate. The authorized individual, typically a physician or clinic, needs to sign and date where indicated. Ensure all signatures are clear and legible.
  6. Submit the Form. Finally, deliver the completed Form 680 to the appropriate school or childcare facility where it will be kept on record.

Once you’ve filled out the form, keep a copy for your records. It's also a good idea to check in with the school or childcare facility to ensure they received it and that everything is in order.

What You Should Know About This Form

What is the purpose of the Florida Certification of Immunization (680 form)?

The 680 form certifies that a child has received necessary immunizations required for school attendance in Florida. This documentation is required for enrollment in K-12 programs, daycare, and other educational settings. It ensures that children are protected against vaccine-preventable diseases, promoting public health and safety.

Who is responsible for completing the 680 form?

The parent or guardian of the child is responsible for completing the 680 form. They must provide the child’s relevant information, including the name, date of birth, social security number (optional), and immunization dates. A licensed physician or authorized clinic must verify and sign the form, confirming that the immunization records are accurate and up to date.

What types of immunizations are documented on the 680 form?

The 680 form includes a variety of immunizations required for school entry, such as DTaP/DTP, Polio, MMR, Hepatitis B, and Varicella. Each vaccine must be listed with its respective doses and dates. The required vaccines may vary for different grades, particularly for those entering 7th grade.

How do I know which certificate (A, B, or C) to use on the form?

Choosing the correct certificate on the 680 form depends on the child’s vaccination status. Certificate A is for complete immunization records for K-12 (excluding 7th grade), while Certificate B is for those with temporary exemptions. Certificate C is for children who have permanent medical exemptions from certain immunizations. It’s important to consult the applicable requirements for each grade level when making this determination.

What should I do if my child has not completed the required immunizations?

If your child has not completed the necessary immunizations, you should fill out Certificate B on the 680 form. This indicates that the child has started receiving vaccinations but is not yet fully compliant. You must also provide a schedule for completing the required immunizations. It’s critical to stay in touch with your healthcare provider to ensure the child receives all necessary doses promptly.

Where can I find more information about the immunization requirements and guidelines?

For comprehensive information regarding immunization requirements and completion of the 680 form, visit the Florida Department of Health’s website. The guidelines can be found at www.immunizeflorida.org/schoolguide.pdf. This resource provides valuable insights and updates related to immunizations for children in Florida.

Common mistakes

Completing the Florida Certification of Immunization Form (DH 680) can be straightforward, but there are common pitfalls that can lead to delays or errors in processing. Here are ten mistakes frequently made when filling out this form.

One frequent mistake is failing to provide all necessary information. Each section, from the child's name to immunization dates, must be filled out completely. Leaving out even one detail can render the form invalid.

Another common error occurs with dates. Parents often input the dates of immunizations incorrectly, either by not following the MM/DD/YY format or by leaving spaces blank. It’s crucial to double-check these entries to avoid complications.

Inaccurate recording of immunization doses can also lead to issues. Some individuals might skip doses or mistakenly count them, which could suggest that a child is not fully immunized.

Ignoring the optional fields, such as the child's Social Security number or State Immunization ID, poses another problem. While these sections are optional, providing them can improve record-keeping and facilitate future medical needs.

Additionally, not signing the form is a prevalent mistake. A parental or guardian signature is mandatory for the certification to be considered valid. It is essential to sign in the designated area.

Another oversight occurs when people select the wrong certificate type. There are multiple certificates available for different situations. Choosing the incorrect one can result in further complications.

Omitting the expiration date for a temporary medical exemption is another error. Without this date, the exemption cannot be deemed valid. Ensuring that every section is complete is vital.

Misunderstanding the guidelines can lead to confusion. Many parents forget to consult the referenced resources or fail to follow the outlined immunization schedule, potentially jeopardizing their child’s enrollment in school or daycare.

Another frequent error involves not keeping copies of the completed form. Parents often submit the document without maintaining a personal record. It’s advisable to keep a copy for future reference and to verify what has been submitted.

Finally, failing to review the completed form before submission can lead to overlooked mistakes. Taking a moment to double-check all entries can save time and prevent unnecessary issues down the line.

Documents used along the form

The Florida Certification of Immunization, commonly referred to as the 680 form, is essential for demonstrating a child's vaccination status for school enrollment and attendance. Other documents typically accompany the 680 form to provide additional context, medical confirmations, or legal authorizations. Below is a list of commonly used forms that align with the 680 form.

  • DH Form 150-615: This document includes immunization guidelines for Florida schools, childcare facilities, and family daycare homes. It details the necessary immunizations required for school entry and outlines the process for completing the 680 form.
  • Temporary Medical Exemption Form: This form is required when a child cannot receive vaccinations for medical reasons. Parents or guardians must specify the duration for which the exemption applies, ensuring clarity on the child's vaccination status during this time.
  • Permanent Medical Exemption Form: Used for children with long-term medical conditions preventing vaccination, this form requires a healthcare provider's verification. It details the specific vaccines the child is exempt from and the reasons supporting the exemption request.
  • Form 3040 - Health Examination Report: Often required alongside the 680 form, this report serves to verify a child's overall health status. The health examination may need to be completed by a licensed healthcare provider and is vital for school compliance.

Each of these documents aids in ensuring that a child meets the required health standards for school attendance while providing necessary legal and medical context where applicable.

Similar forms

  • Immunization Records Release Form: This document allows parents to grant permission for the release of their child's vaccination records to schools or other entities. Like the 680 form, it involves authorizing access to important health information.
  • Certificate of Immunization Compliance: This is used to show that a child's immunizations meet specific state requirements. Similar to the 680 form, it provides a checklist of required vaccinations.
  • Medical Exemption Form: This document is completed when a child cannot receive certain immunizations for medical reasons. It parallels Part C of the 680 form by requiring similar documentation of medical contraindications.
  • School Enrollment Form: Often required for new students, this form gathers essential information including health details. This is similar to the 680 form's purpose of ensuring compliance for school entry.
  • Child Health Assessment: This document provides a comprehensive evaluation of a child's health, including immunization status. It shares the same objective of documenting health information necessary for school attendance.
  • State Vaccination Records: A government-issued document detailing a person's vaccination history. This serves a similar function as the 680 form, as both provide proof of immunizations.
  • Daycare Enrollment Form: Required in daycare settings, this form often includes health and immunization information. Like the 680 form, it ensures children are adequately protected against preventable diseases.
  • Immunization Exemption Form: Used for families that wish to claim personal or religious exemptions from vaccination. This is similar to the 680 form’s sections on exemptions due to medical reasons.
  • Health Insurance Portability and Accountability Act (HIPAA) Authorization Form: This allows for the disclosure of medical information, similar to the 680 form's function of sharing immunization information for enrollment purposes.
  • Vaccine Information Statements: These documents provide essential information about vaccines. Like the 680 form, they are educational resources meant to inform parents about immunizations.

Dos and Don'ts

When filling out the Florida Certification of Immunization (Form 680), it's essential to follow certain guidelines to ensure the process runs smoothly. Here are five actions to take and avoid:

  • Do read the instructions carefully before you begin.
  • Do ensure all sections are complete with accurate information.
  • Do have the necessary vaccination records readily available.
  • Do sign and date the appropriate certificate at the end of the form.
  • Do double-check the child's age in relation to immunization requirements.
  • Don’t leave any fields blank unless specified as optional.
  • Don’t provide incorrect or outdated vaccination dates.
  • Don’t forget to include the physician's signature.
  • Don’t submit the form without necessary supporting documents.
  • Don’t ignore guidelines related to medical exemptions if applicable.

Misconceptions

  • Misconception 1: The FL 680 form is only for children entering kindergarten.
  • Many people believe that the FL 680 form is solely intended for kindergarten students. In reality, this form is required for all students entering K-12, including preschool and daycare settings. It is essential for maintaining accurate vaccination records across all grade levels.

  • Misconception 2: Completing the FL 680 form is optional.
  • Some parents assume that completing the FL 680 form is not mandatory. However, schools and childcare facilities in Florida require this form as proof that children have received the necessary immunizations. Failure to provide this documentation can result in a child being excluded from school or daycare.

  • Misconception 3: Any physician can fill out the form.
  • While it may seem that any doctor could complete the FL 680 form, it must be filled out by a licensed physician or authorized healthcare provider. This ensures that the vaccination history is credible and meets legal standards.

  • Misconception 4: The expiration date for exemptions is not necessary.
  • Individuals often think that an expiration date on the Temporary Medical Exemption is optional. This is a misunderstanding. A valid expiration date is critical, as it determines when the exemption is no longer applicable and helps ensure timely compliance with immunization requirements.

  • Misconception 5: The FL 680 form covers all medical exemptions.
  • Some may believe that the form can be used for any medical exemption. However, it only provides space for permanent exemptions related to medically contraindicated immunizations. Each exemption must have clear clinical justification to be accepted.

  • Misconception 6: Parents can sign the form without consulting a healthcare provider.
  • There is a misconception that parents can simply certify vaccination records without any healthcare provider input. In fact, a qualified healthcare provider must verify the information before the parent or guardian signs the form, ensuring accuracy and accountability.

  • Misconception 7: The form does not require additional records.
  • Some believe that the FL 680 form is complete in itself and does not require additional documentation. However, parents must attach official vaccination records from the healthcare provider, as these records support the information recorded on the form.

  • Misconception 8: Once the form is submitted, no further action is needed.
  • This misconception leads some to think that the process ends with the submission of the form. In reality, parents should regularly review and update their child's vaccination status, particularly as new immunizations are recommended or mandated by health authorities.

  • Misconception 9: Exemptions mean vaccinations are unnecessary.
  • Some families mistakenly believe that if they receive an exemption, their child does not need any vaccinations. This is not true. Exemptions are specific to certain circumstances and do not negate the overall importance of vaccinations for public health and individual safety.

Key takeaways

When filling out the Florida Certification of Immunization Form 680, there are several essential points to keep in mind to ensure smooth processing and compliance with state requirements.

  • Accurate Information: It is crucial to enter precise information for the child's name, date of birth, and immunization records. Mistakes can lead to delays or denial of entry into school.
  • Document Immunization Dates: Make sure to record the dates accurately for each vaccination dose. Use the format MM/DD/YY as specified to avoid confusion.
  • Certificate Completion: Sign and date the appropriate certificate section (A, B, or C) after entering all relevant information. This acts as a certification of the child's immunization status.
  • Check for Exemptions: If applicable, be aware of the temporary or permanent medical exemption options available. Proper documentation and a physician's signature are necessary for these exemptions to be valid.
  • Guidelines for Compliance: Familiarize yourself with the guidelines from the Florida Department of Health. The publication available at www.immunizeflorida.org/schoolguide.pdf offers helpful instructions and clarity regarding form completion.

By adhering to these guidelines, you ensure that the form is correctly filled out and that your child meets the necessary immunization requirements for school attendance in Florida.